Provider Demographics
NPI:1942241906
Name:SILBERG, MIRA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MIRA
Middle Name:
Last Name:SILBERG
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13975 CONNECTICUT AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2921
Mailing Address - Country:US
Mailing Address - Phone:301-275-1376
Mailing Address - Fax:
Practice Address - Street 1:13975 CONNECTICUT AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2921
Practice Address - Country:US
Practice Address - Phone:301-275-1376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD114921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD491774Medicare UPIN